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ON-LINE APPLICATION FOR BANK OF BARODA PROBATIONARY OFFICERS RECRUITMENT PROJECT

34037
Please paste your recent
passport size photograph
and sign across it. Please
retain atleast 5 copies of
same photograph with you
for subsequent use.

Registration # : 487645
Full Name : Ms GOIA POORNIMA
Category : SC
If Person with Disability : NO
Type of Disability : -- Percentage of Disability : --

Do you intend to use the services of a scribe( only for VH and

--
OH candidates whose writing speed is affected by cerebral palsy) :
Are you candidate who had ordinarily been domiciled in Kashmir
NO
Division of the State of J&K during the period 1-1-1980 to 31-12-1989?
Whether you belong to Religious Minority Community NO
Minority Religion : --
Are you an Ex-Serviceman (Including ECO/SSCO)? NO

Preference for Posting :

Preference1 : MADHYA PRADESH
Preference2 : DELHI

Preference3 : MANIPUR
Are you an employee of Bank of Baroda : NO
If yes,E. C. No :
Nationality : INDIAN
Centre of Examination : Bhopal
Centre code : 22

Application Fee / Postal Charges Details :

Transaction ID : M1086632
Branch Name : HOSHANGABAD

Branch Code No : 3008

Deposit Date : 24-01-2011

Amount : 50

Personal Details :
Date of Birth : June 16,1986 Age as on on 01.01.2011. : 24
Gender : FEMALE

Father's Name/ Husband's Name : LAXMI KANT GOIA

Mother's Name : INDU GOIA

Email ID : poornima.gohiya@gmail.com
Address for Correspondence : Q NO F-3 SECURITY PAPER MILL

COLONY HOSHANGABAD

MADHYA PRADESH
 2/2
District HOSHANGABAD

State : MADHYA PRADESH

Pin : 461005

Permanent Address : Q NO F-3 SECURITY PAPER MILL

COLONY HOSHANGABAD

MADHYA PRADESH
District HOSHANGABAD

State : MADHYA PRADESH

Pin : 461005

Contact Details:
Phone No : 07754-279885

Mobile No: 9179627083

Qualification Details (as on 01.01.2011):

Exams Passed Subject/Stream University / Board Year Of Passing % of Marks

Graduation : BCA BARKATULLA UNIV 10-05-2010 58.00

Possess certificate in computer literacy : YES

Post qualification work experience details as on 01.01.2011 (Start from Present Employer) :

No Experience

Other Details :

Whether desirous of taking Pre-Exam Training

NO
(SC/ST/PWD/Minority Community) :

If Yes Centre for Training : --

Languages
Read Write Speak
Known
ENGLISH YES YES YES

HINDI YES YES YES

DECLARATION:

I hereby certify that the information furnished above is correct to the best of my knowledge and belief. I have not suppressed any material fact or
factual information in the above statement. I am aware, that, in case, I have given wrong information or suppressed any material fact or factual information or, I
do not satisfy the eligibility criteria according to the advertisement, then my candidature will be rejected/services terminated even after permanent employment
without giving any notice or reasons thereof.

I hereby certify that I am satisfying the eligibility criteria for the post applied for in terms of the advised criteria in respect of age, educational
qualification and experience, etc.

I am also willing to serve anywhere in India. I agree that the Bank has the right to transfer me to any part of the country and/or to any
job position at its sole discretion in terms of applicable staff rules from time to time.

I hereby agree that any legal proceeding in respect of any matter(s) or claims or disputes arising out of this application or out of said
advertisement can be instituted by me only at Mumbai and Courts/Tribunal/ Forums at Mumbai only, shall have sole and exclusive jurisdiction to try any
cause/dispute. I undertake to abide by all the terms and conditions mentioned in the advertisement given by the Bank.

Place:
Date: 24-01-2011 Signature of Applicant

GOIA POORNIMA
Please retain your Registration No. and Password emailed to you carefully for further reference
NOTE: Please DO NOT SEND application print-out to the Bank